Dentistry Activity for 2018 Activity No: B9 (18) 2021 Topic
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Dentistry
Activity for 2018
Activity No: B9 (18) 2021
Topic
Oral Hygiene Status
Article
Effects of Ultrasound and Sonic Toothbrushes on Oral Hygiene Status
Speciality
Oral Pathology
Approved for ONE (1) Clinical Continuing Educational Unit (CEU)
Journal of Oral Hygiene and Health Takenouchi A et al., J Oral Hyg Health 2016, 4:5
DOI: 10.4172/2332-0702.1000208
Research OMICS International
Effects of Ultrasound and Sonic Toothbrushes on Oral Hygiene Status
Akane Takenouchi*, Takashi Matsukubo, Miwa Sakurai Matsukubo, Yukiko Satoho, Hiroe Arai, Etsuyo Otani and Yumiko Kakegawa
Taiyo Schoold of Dental Hygiene, Arakawa-ku, Tokyo, Japan
*Corresponding author: Akane Takenouchi, BOH, RDH, Taiyo School of Dental Hygiene, 116-0013 Tokyo, Arakawa-ku, Nishi-Nippori 2-22-1, Station Plaza Tower 6F,
Japan, Tel: (+81)03-5810-8020; Fax: (+81)03-5810-8023; E-mail: lisa_serugio4@hotmail.co.jp
Received date: October 06, 2016; Accepted date: November 10, 2016; Published date: November 17, 2016
Copyright: © 2016 Takenouchi A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Objective: To evaluate the effects of ultrasound and sonic toothbrushes on the oral hygiene status of healthy
people.
Methods: This study was administered with a randomized, controlled, and double-blind trial. Twenty-nine first-
year dental hygiene students answered a questionnaire on oral hygiene behavior, and they were divided into one of
four groups after pre-examination. Each group used an electronic toothbrush with different modes (2 times/day, 3
min) after tooth brushing instruction (TBI) for four weeks; A (control): used with power off; B: used with the sonic
mode (sonic wave: 16,000 strokes/min); C: used with the ultrasound mode (ultrasound frequency: 1.6 MHz); D: used
with the ultrasound + sonic mode. The plaque index (PlI) and gingival index (GI) were assessed. The unstimulated
saliva flow rate was measured (spitting method, 1 min). The Ethical Committee of the Japan Dental Hygienists’
Association approved this study’s protocol (vote number: 2). A Wilcoxon signed-rank test was used.
Results: The PlI decreased in group C (baseline: 1.42 ± 0.83; 4 weeks: 0.92 ± 0.34; p
Citation: Takenouchi A, Matsukubo T, Matsukubo MS, Satoho Y, Arai H, et al. (2016) Effects of Ultrasound and Sonic Toothbrushes on Oral
Hygiene Status. J Oral Hyg Health 4: 208. doi:10.4172/2332-0702.1000208
Page 2 of 4
Examined electronic toothbrush Clinical trials
Ultrasound Toothbrush ReClean (ASAHI IRICA CO., LTD) was This study was administered with a randomized, controlled, and
used [8]. In this research, each participant used this electronic double-blind trial. Participants were numbered, and all of the results of
toothbrush with different modes: the manual mode, the lamp was off, this study were treated numerically (Figure 2).
and the toothbrush was used manually with power off; the sonic mode,
the lamp was off, and sonic waves of 16,000 strokes/minute were used;
the ultrasound mode, the green lamp was turned on, and an
ultrasound frequency of 1.6 million Hz was used; the ultrasound and
sonic mode, the red lamp was turned on, and sonic waves plus
ultrasound were used (Figure 1).
Figure 2: Flow chart of participants’ enrollment.
First, 33 participants received pre-examination. The results of the
Figure 1: Examined electronic toothbrush with four modes: manual plaque index (PlI), gingival index (GI), and unstimulated saliva flow
mode, lamp was off, used the toothbrush with power-off manually; rate were utilized to divide participants randomly into one of four
the sonic mode, lamp was off, sonic waves were 16,000 strokes/ groups: A (control): used with power off, B: used with the sonic mode,
minute; the ultrasound mode, green lamp was turned on, C: used with the ultrasound mode, D: used with the ultrasound + sonic
ultrasound frequency was 1.6 million Hz; the ultrasound and sonic mode.
mode, red lamp was turned on, sonic waves plus ultrasound. Second, participants received TBI, they were given an examined
electronic toothbrush, and they used it with the allocated mode two
times a day for three minutes over four weeks. After that, they received
Once users pushed the button, this toothbrush moved for three an examination.
minutes with a vibration alarm every 45 seconds. Participants were not
informed which mode they used. All of them pushed the button once
Measurements
or twice, though it did not work when participants used the toothbrush
with the power off. Participants answered if they had received TBI before this research
at pre-examination. Oral pictures were taken, and a masked examiner
Tooth brushing instruction (TBI) assessed the Quigley-Hein plaque index (PlI) and Silness and Lӧe
gingival index (GI) viewing the oral pictures and the results of bleeding
At the first visit, participants received TBI. This study involved four on probing. The unstimulated saliva flow rate was measured using a
operators, and they did TBI following the manual that the spitting method for 1 minute.
manufacturer had created. Therefore, we can say that all of the four
operators conducted common TBI for every participant. These are the
Statistical analysis
five points in the TBI: (i) every participant used an electronic
toothbrush with fluoride dentifrice, (ii) the scrubbing tooth brushing A Wilcoxon signed-rank test was used for statistical analysis to
technique was taught, (iii) the mouth was closed during tooth brushing compare the intragroup differences between baseline and after four
to heighten the effects of ultrasound, (iv) enough buccal mucosa was weeks in all measurements by group. Group A and B and group C and
removed for the toothbrush to reach the cervical areas on molar teeth, D were combined into the “Group without ultrasound” and the “Group
(v) participants brushed their teeth using an examined toothbrush two with ultrasound,” respectively. After that, the changes in all
times a day for three minutes. measurements were compared by ultrasound. The Krusal Wallis test
was also used to evaluate intergroup differences after four weeks. JMP
All examined modes in toothbrushes except manual mode had a
version 11 for Windows (Statistical Discovery, From SAS) was used for
vibration alarm system every 45 seconds. Therefore, participants
statistical analysis, and p-values
Citation: Takenouchi A, Matsukubo T, Matsukubo MS, Satoho Y, Arai H, et al. (2016) Effects of Ultrasound and Sonic Toothbrushes on Oral
Hygiene Status. J Oral Hyg Health 4: 208. doi:10.4172/2332-0702.1000208
Page 3 of 4
Results PlI
Twenty-eight participants completed the clinical trials (mean age: 22 All groups showed the tendency of a decrease in the PlI, and
± 6.99). Four of the participants were excluded after the pre- significant differences were found in Group C (baseline: 1.42 ± 0.83; 4
examination because they did not meet the inclusion criteria, and data weeks: 0.92 ± 0.34; pCitation: Takenouchi A, Matsukubo T, Matsukubo MS, Satoho Y, Arai H, et al. (2016) Effects of Ultrasound and Sonic Toothbrushes on Oral
Hygiene Status. J Oral Hyg Health 4: 208. doi:10.4172/2332-0702.1000208
Page 4 of 4
vibration of ultrasound was effective to remove biofilms on the teeth Association Co.) editing of the manuscript is really appreciated by the
including noncontact surfaces, to stimulate the saliva gland, and to authors. This study was conducted with the help of the Ito Co.
improve oral hygiene status. Using technology to improve oral hygiene Examined electronic toothbrushes were supplied by the Ito Co.
status should be promoted because electronic toothbrushes showed
higher benefits than a certain standard for all participants regardless of References
their tooth brushing technique. More RCT related to ultrasound
toothbrushes are required to heighten their credibility and to get more 1. Costa MR, Marcantonio RA, Cirelli JA (2007) Comparison of manual
people to use them. In this process, dental professionals could keep versus sonic and ultrasonic toothbrushes: a review. Int J Dent Hyg 5:
75-81.
learning about ultrasound or ultrasonic, which is used widely in dental
treatment—not only in professional prophylaxis but also in root canal 2. Yaacob M, Worthington H, Deacon S, Deery C, Walmsley A, et al. (2014)
Powered versus manual tooth brushing for oral health. Cochrane
treatments [11-13]. Actually, dental hygiene education programs will Database Syst Rev CD002281.
be changed to reflect a contemporary approach to ultrasonic
3. Schmidt JC, Zaugg C, Weiger R, Walter C (2013) Brushing without
instrumentation [14]. brushing? A review of the efficacy of powered toothbrushes in noncontact
Second, professional prophylaxis is essential to improve gingival biofilm removal. Clin Oral Investig 17: 687-709.
status, though it was not implemented in this research. Hence, this 4. Forgas-Brockmann LB, Carter-Hanson C, Killoy WJ (1998) The effects of
an ultrasonic toothbrush on plaque accumulation and gingival
study showed the pure effects of the use of electronic toothbrushes and
inflammation. J Clin Periodontol 25: 375-379.
identified that only self-care was insufficient to improve gingival status
5. Goldman HM (1974) Effectiveness of an ultrasonic toothbrush in a group
because no toothbrushes could remove biofilms in periodontal of uninstructed subjects. J Periodontol 45: 84-87.
pockets. Thus, these biofilms should be removed by professional
6. Deery C, Heanue M, Deacon S, Robinson PG, Walmsley AD, et al. (2004)
prophylaxis including ultrasonic scaling or debridement utilizing The effectiveness of manual versus powered toothbrushes for dental
cavitation [15–17] because previous research showed that the quality health: A systematic review. J Dent 32: 197-211.
of self-performed mechanical plaque removal was not sufficiently 7. Ohara Y, Yoshida N, Kono Y, Hirano H, Yoshida H, et al. (2015)
effective in adults with gingivitis [18]. If professional prophylaxis had Effectiveness of an oral health educational program on community-
been included in this research, gingival status would likely have dwelling older people with xerostomia. Geriatr Gerontol Int 15: 481-489.
improved, as previous research has shown [19]. 8. (2003) Ultrasound Toothbrush ReClean Japanese. Ito Co.
Third, TBI enabled participants to use electronic toothbrushes more 9. Hashizume LN, Dariva A (2015) Effect of sonic vibration of an ultrasonic
toothbrush on the removal of Streptococcus mutans biofilm from enamel
effectively to stimulate the saliva gland. Whether or not users could
surface. Am J Dent 28: 347-350.
remove enough buccal mucosa for toothbrushes to reach cervical areas
10. Howlin RP, Fabbri S, Offin DG, Symonds N, Kiang KS, et al. (2015)
was very important. The point was whether or not the saliva gland was Removal of dental biofilms with an ultrasonically activated water stream.
exposed to ultrasound. Actually, previous research showed that the J Dent Res 94: 1303-1309.
learning effect had a higher impact on improvement in oral hygiene 11. Jiang LM, Verhaagen B, Versluis M, Zangrillo C, Cuckovic D, et al. (2010)
[20]. Furthermore, some users may misunderstand how to use An evaluation of the effect of pulsed ultrasound on the cleaning efficacy
ultrasound toothbrushes, for instance, they might just put the head of of passive ultrasonic irrigation. J Endod 36: 1887-1891.
the toothbrush on the tooth surfaces but not move it, which is 12. Jiang LM, Verhaagen B, Versluis M, Langedijk J, Wesselink P, et al. (2011)
completely different from how to use sonic toothbrushes. Users should The influence of the ultrasonic intensity on the cleaning efficacy of passive
receive TBI before using any kind of electronic toothbrushes. ultrasonic irrigation. J Endod 37: 688-692.
13. Macedo RG, Verhaagen B, Rivas DF, Versluis M, Wesselink P, et al. (2014)
The population of this study was healthy youngsters; moreover, they Cavitation measurement during sonic and ultrasonic activated irrigation.
were dental hygiene students. This was one of the limitations in this J Endod 40: 580-583.
research. Hence, the results of this study cannot be generalized; 14. Asadoorian J, Botbyl D (2015) Dental hygienists’ perception of
however, this study showed the highly possibility that the preparation and use for ultrasonic instrumentation. Int J Dent Hyg 13:
imperceptible vibration of ultrasound was effective in improving the 30-41.
PlI as well as in stimulating the saliva gland to increase the 15. Felver B, King DC, Lea SC, Price GJ, Damien Walmsley A (2009)
unstimulated saliva flow rate. Whether or not the same results will be Cavitation occurrence around ultrasonic dental scalers. Ultrason
obtained for older people will be identified in our future research. Sonochem 16: 692-697.
16. Walmsley AD, Lea SC, Felver B, King DC, Price GJ (2013) Mapping
cavitation activity around dental ultrasonic tips. Clin Oral Investig 17:
Conclusion 1227-1234.
Electronic toothbrushes with ultrasound were effective to improve 17. Derdilopoulou FV, Nonhoff J, Neumann K, Kielbassa AM (2007)
oral hygiene of dental hygiene students; however, patients should visit Microbiological findings after periodontal therapy using curettes, Er:
YAG laser, sonic, and ultrasonic scalers. J Clin Periodontol 34: 588-598.
dental clinics and receive TBI before using it to heighten the effects of
ultrasound. In doing so, patients will receive professional prophylaxis 18. Van Der Weijden GA, Hioe KPK (2005) A systematic review of the
effectiveness of self-performed mechanical plaque removal in adults with
and improve their gingival status, as well. gingivitis using a manual toothbrush. J Clin Periodontol 32: 214-228.
19. Zimmer S, Nezhat V, Bizhang M, Seemann R, Barthel C (2002) Clinical
Acknowledgement efficacy of a new sonic/ultrasonic toothbrush. J Clin Periodontol 29:
496-500.
The authors thank the dental hygiene students who participated in
20. Lazarescu D, Boccaneala S, Illiescu A, De Boever JA (2003) Efficacy of
this study and the Taiyo School of Dental Hygiene students and plaque removal and learning effect of a powered and a manual
educators who assisted in this research. Michael Bayne’s (Kurdyla and toothbrush. J Clin Periodontol 30: 726-731.
J Oral Hyg Health, an open access journal Volume 4 • Issue 5 • 1000208
ISSN: 2332-0702QUESTIONNAIRE
B9(18)
Effects of Ultrasound and Sonic Toothbrushes on Oral Hygiene Status
INSTRUCTIONS
Read through the article and answer the multiple-choice questions provided below. There is only ONE correct answer to each
question.
Question 1: Which one of the following is TRUE regarding saliva Question 4: Is it TRUE or FALSE that ultrasound vibrations are
flow rate? able to remove biofilms on teeth including noncontact
surfaces, to stimulate the saliva gland and to improve oral
A: Previous studies have evaluated the change in saliva flow hygiene status?
rate due to use of different toothbrushes
B: Change in saliva flow rate has a substantial impact on A: TRUE
oral hygiene B: FALSE
C: Electric toothbrush vibrations can decrease the saliva
flow rate Question 5: Which one of the following limitations prevents
D: Saliva flow rate is normally increased in dehydrated the results of the study to be generalized?
individuals
A: The participants were all students
Question 2: Which one of the following is FALSE regarding the B: The participants were all female
Tooth Brushing Instruction (TBI) the participants received? C: The participants were all young and healthy
END
A: Participants used toothbrushes with fluoride dentifrice
B: The participant’s mouth should be open during tooth
brushing to heighten the effects of the ultrasound
C: Enough buccal mucosa was removed for the toothbrush
to reach the cervical areas on molar teeth
D: Participants brushed their teeth for two minutes (three
times per day)
Question 3: What was the effect of using ultrasound on the
Quigley-Hein plaque index (PlI) and Silness and Lӧe gingival index
(GI) in all groups?
A: Decrease in PlI and increase in GI
B: Increase in PlI and in GI
C: Increase in PlI and decrease in GI
D: Decrease in PlI and no significant difference in GI400 Theuns van Niekerk Street
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